Archive for May, 2015

I got covered. What’s next?

May 5, 2015

Many people now have quality, affordable health insurance for the first time in many years — or even for the first time in their lives. That’s such great news!

If that includes you, you might have a lot of questions about your new health insurance plan. Here’s a quick checklist to help you get started:

  1. Make sure to pay your premium (that’s your monthly cost) to your health insurance company each month.
  2. Look over your summary of benefits and coverage. That’s a document that explains what services and costs are covered by your plan.
  3. Make a note of the out-of-pocket costs for your plan, which are also explained in the summary of benefits and coverage. This will help you understand what costs your plan covers and what your share will be.
  4. Find a primary care doctor in your network. This doctor will be your first stop for checkups, minor injuries, or minor illnesses.
  5. Schedule a checkup with your primary care doctor. Remember: Preventive care is free.

If you have questions about your plan, simply give your insurer a call.

I got covered. Do I need to do anything to stay covered?

August 22, 2014

Here are a few quick steps to take to stay covered:

  1. Log into your marketplace account and update your information to find out what financial help you qualify for.
  2. Shop around in the Marketplace and review the plans available in your area.
  3. Pick a plan that fits your needs and your budget. If you like your current plan, keep it.

The amount of financial help that you qualify for could change, or you may want to see if there’s a plan that better fits your needs and your budget. Remember: Renew your current plan or sign up for a new plan by December 15th to avoid a gap in coverage!

If you have questions, don’t forget that free help is available in your community.

Find local help!

How much will it cost to visit a doctor?

June 3, 2014

Your share of the cost of health care services (in addition to your monthly payment) is called out-of-pocket costs. There are 3 kinds of costs that you might have to pay:

  1. Deductible. You must pay this amount each policy period (which usually lasts one year) for covered services before your insurance kicks in. You do not pay a deductible until you receive health care services. You may not pay the full amount each year. For example, if your deductible is $1,500, you will pay 100% of your health care costs until you have spent $1,500. Preventive care (such as annual checkups) is free, and does not count toward your deductible.
  2. Copay, or copayment. A copay is a set amount that you pay for health care services. For example, you might have a $25 copay for visits to your doctor, or a $75 copay  for emergency room visits. Copays usually do not count toward your deductible, but check with your plan to be sure.
  3. Coinsurance. Coinsurance is the portion of health care costs that you are responsible for once you’ve met your deductible. It’s usually a percentage, such as 20%. For example, if a doctor visit costs $500 and your co-insurance is 20%, your share is $100.

Your out-of-pocket costs are capped by an out-of-pocket maximum (or out-of-pocket limit), which is the most you will have to pay during a policy period (which usually lasts one year).

The amount of the deductible, copay, coinsurance, and out-of-pocket maximum for your plan is explained in a document called the summary of benefits and coverage. If you have questions, contact your health insurance plan.

How do I find a doctor or other health care provider with my plan?

Your health insurance plan has a group of health care providers (doctors, hospitals, pharmacies, and more) that are part of the plan’s provider network.

A provider network is a group of health care providers that have partnered with your plan to provide health care services at lower costs. These providers are called in-network providers.

Doctors and other health care providers who have not partnered with your health insurance plan are called out-of-network providers.

Your share of the cost for health care services will likely be different for in-network providers and out-of-network providers. Seeing an out-of-network provider often costs more than seeing an in-network provider.

Tip: Provider networks can change. Before getting care, it’s best to call your provider and ask if they accept your health insurance plan.

You can call your insurance company to learn about out-of-network costs and in-network costs, and look over your summary of benefits and coverage (SBC) for specific details about your plan.

How do I know if a prescription drug is covered?

Before you fill a prescription, take these two steps to keep your costs as low as possible:

  1. Pick a pharmacy that is in-network.
  2. Check with your plan to make sure your prescription drug is covered.

All health insurance plans offered in the marketplace must cover prescription drugs. Each plan has a list of specific drugs that it covers.

Drugs that are on your plan’s drug list usually cost you less than drugs that are not on the list. It’s a good idea to ask your doctor or pharmacist if a drug is covered by your health insurance plan. You can also contact your health insurance company to see if a drug is covered by your plan.

Sometimes, a generic version of your drug is available. Generic drugs often cost you less money.

If you need a prescription drug that is not covered by your plan, you might be able to ask your doctor for a different drug. Your doctor can also ask your health insurance plan to make an exception and cover the drug.

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